Different patterns in essential hypertension and possible choice of antihypertensive drugs

Essential hypertension is not a disease entity, so therefore it is understood that there are several causes of its development. The hemodynamic relation is not the same in all patients. The traditional concept of an increased total peripheral resistance (TPR) and a normal cardiac output (CO) is not valid for all cases. We developed a method to estimate a measure for TPR independently of the CO. The results in six patients are described: three of them show a hemodynamic pattern of increased CO and normal TPR, two of increased TPR and normal CO, while the sixth patient shows a mixed pattern. These results have important implications for therapy: drugs lowering CO are more indicated in the first group, drugs influencing TPR promise a better result in the second one. Furthermore a review is given of other mechanisms governing the bloodpressure and indicating a special kind of treatment, i.e., the reninangiotensin-aldosteron system and the catecholamines.

we know some important determinants of high blood pressure. Most of them can be determined, but in general praxis this is too troublesome. However, for very difficult cases it is now possible to try and find the most promising combination of drugs for that particular case.